MWH. BUILDING A BETTER WORLD

August 20, 2012

Mr. Kurt F. Hildebrandt Drinking Water and Groundwater Management Branch (WWPD/DWGM/UIC) U.S. Environmental Protection Agency 901 North 5 t h Street Kansas City, KS 66101 MWH #10500630.010101

RE: Underground Injection - Rule Authorization Request Former Peoples Natural Gas Site Dubuque, Iowa

Dear Mr. Hildebrandt:

MWH has been retained by MidAmerican Energy Company (MidAmerican) to provide environmental assistance at the former Peoples Natural Gas (PNG) site located at 925 Kerper Boulevard in Dubuque, Iowa. A new groundwater extraction system comprised of three extraction wells and conveyance piping is being designed to operate as part of remedial activities for the site. The groundwater extraction system is intended to minimize the potential for further migration of constituents of concern in the silty sand alluvial aquifer toward the Mississippi River. The United States Environmental Protection Agency, Region VII (USEPA) Superfund Division is providing regulatory oversight of the remedial activities at the site.

Based on the known groundwater quality, significant fouling of the remedial system is expected over time by iron content, hardness, and iron-related biofilms. To mitigate operational issues caused by poor water quality, the addition of deposit control agents into each groundwater extraction well is included in the remedial design. USEPA regulates underground injections in the state of Iowa through the Underground Injection Control (UIC) program and, based on our previous conversations, addition of the deposit control agents into an extraction well would be considered a Class V Injection Well and could be completed under a Rule Authorization.

Deposit Control Agent Information

The specified deposit control agents are Redux 300, an inorganic sequestering agent; and Redux 620, a biodispersant. Both deposit control agents are manufactured by Redux Technology of Newfane, Vermont. A Material Safety Data Sheets (MSDS) for each product is included in Attachment A.

Proposed Injection Locations, Volume, and Procedures

The site location and proposed extraction well locations are presented in Figures 1 and 2, respectively. The Redux 300 and Redux 620 deposit control agents will be added to each well through two separate chemical feed pumps dedicated to each well and controlled by the well

11153 Aurora Avenue Des Moines, IA 50322-7904

TEL 515 253 0830 FAX 515 253 9592 www.mwhglobal.com

Mr. Kurt F. Hildebrandt Page 2 August 20, 2012

groundwater extraction pump. Therefore, chemical feed will cease any time the extraction pump is not operating (i.e., the deposit control agents should not migrate from the well into the aquifer). The remedial design calls for each of the three extraction wells to be operated at an extraction rate of 1. gpm. Redux 300 will be added through continuous feed to each well for a dosage of approximately 2.3 pounds (or 0.25 gallon) per day per well (based on a 1 gpm/well groundwater extraction rate). Redux 620 will be added through periodic (slug) feed to each well at a concentration of 400 parts per million for 60 minutes a day. At 1 gallon per minute flow per well, this equates to a dosage of 0.2 pound (or 0.02 gallon) per day per well. ­

Proposed Schedule and Future Reporting

.Operation of the groundwater extraction system is proposed to begin in the fourth quarter of 2012 and will likely continue indefinitely. Sample collection and analysis of the combined well extracted groundwater prior to discharge to the sanitary sewer is anticipated to be conducted monthly for the first year pf operation and quarterly during subsequent years of operation. Annual reports will be prepared and submitted to the USEP A Superfund Division. Copies of all USEPA-required reports and notifications will be provided to UIC at the time of submittal to the Superfund Division.

Shallow Injection Well Registration/Information Verification Record

The completed Shallow Injection Well Registration/Information Verification Record for the site is provided in Attachment B. A single Registration/Information Verification Record is provided because all three extraction well and chemical feed systems are to be completed based on the same design.

MWH requests a Rule Authorization letter be issued following UIC review of this submittal. Your assistance in allowing this project to proceed on the proposed schedule is greatly appreciated. If you have any questions or require additional information, feel free to contact me at .515-253-0830.

Sincerely,

JTf/y;, Tj ̂ Ai^Tiy Kevin G . Armstrong, C.P.G . Project Manager

/khw:vas Attachnients cc: Jennifer Mclvor, MidAmerican

Diana Engeman, USEP A

P:\Word PrDcessing\MIDAMERICAN ENERGY\DUBUQUE-PNG SITE\08-12_Rule Authorization Request\Ltr-08-12-Hildebrandt-Rule Authorization Request.doc

MAP SOURCE: U.S.G.S. 7.5 MINUTE TOPOGRAPHIC QUADRANGLES DUBUQUE NORTH, lOWA-WISCONSIN-ILUNOIS (1956, PHOTOREVISED 1972) DUBUQUE SOUTH, IOWA-ILLINOIS (1955 , PHOTOREVISED 1972)

QUADRANGLE LOCATION SITE LOCATION: SCAL E IN FEET

TOWNSHIP 89N , RANGE 3E , SECTION 19, DUBUQUE COUNTY, IOWA

DES MOINES IOWA MIDAMERICAN ENERGY COMPANY

PEOPLES NATURAL GAS SITE Srt E LOCATION MAP ® MWH DUBUQUE, IOWA

LEGEND

WATER TABLE MONITORING WELL

SILTY SAND MONITORING WELL

ALLUVIAL AQUIFER MONITORING WELL

ABANDONED MONITORING WELL

TECHNICAL IMPRACTICABILITY ZONE

lESlGNEO BY KEVIN ARMSTRONG DES MOINES, IOWA JRAWN BY NORA DAY PROJECT MIDAMERICAN E N E R G Y C O M P A N Y ^̂ MWMWHH:HECKED BY U QERINGER 0 120 P E O P L E S NATURAL GAS SITE ^ P P R O V E D a Y KEVIN ARMSTRONG U = B = I D U B U Q U E , IOWA >ROJECT ^WNAGER KEVIN ARMSTRONG FIGURFIGUREESCALESCALE ININ FEETFEET PLANNEPLANNEDD

EXTRACTIOEXTRACTIONN WELWELLL LOCATIONLOCATIONSS 22

ATTACHMENT A

O MWH

nEDUXSTECmLOliK Division of Azure Water Services, LLC

Material Safetv Data Sheet

Product Name: Redux 300 Effective date: 12/15/2009 MSDS#: 15 Page 1 of 6

SECTION 1 - CHEMICAL PRODUCT AND COMPANY IDENTIFICATION

IDENTIFICATION

Produc t Nam e Redux 300 Chemica l Nam e Aqueous,Blended Deposit Control Agent Chemical Family Formula Synonym

COIVIPANY IDENTIFICATION

Redux Technology Division of Azure Water Services, LLC 550 VT Rte. 30, P.O. Box 331 Newfane, VT 05345 Phone: 800-639-9506 Fax: 802-365-4652 Email: info@reduxtech.com

EMERGENC Y TELEPHON E NUMBER

24 hours a day: CHEMTRE C 1-800-424-9300. Number for non-emergency questions concerning MSDS: (802) 365-7200

SECTION 2 - COMPOSITION / INFORMATION ON INGREDIENTS

Componen t C A S # Amoun t (%WA/V)

Water 7732-18-5 -71 % Acrylate Copolymer Not Hazardous -4 % Organic Phosphorous Compound Proprietary ~16% Potassium Hydroxide 1310-58-3 -9 %

hEBUX^TECmOLQGl Material Safetv Data Sheet

Product Name: Redux 300 Effective date: 12/15/2009 MSDS#: 15 Page 2 of 6

SECTION 3 - HAZARDS IDENTIFICATION

EMERGENC Y Eye and skin irritant. Prolonged or repeated skin may cause irritation. OVERVIEW

POTENTIA L HEALT H E F F E C T S

INGESTION May cause severe and permanent damages to mouth throat and stomach. May be fatal if swallowed.

INHALATION Damages airways and lungs, depending upon amount and duration of exposure. Effects can vary from irritation to bronchitis or pneumonia.

EYE CONTACT May cause permanent damage, including blindness.

SKIN CONTACT Harmful contact, but may not cause immediate pain.

SECTION 4 ~ FIRST AID MEASURES

INGESTION If swallowed, DO NOT induce vomiting. Immediately drink a large quantity of water. If available, give large quantities of milk. Never give anything by mouth to an unconscious person. Get medical attention immediately. If vomiting occurs spontaneously, keep airway clear.

INHALATION Get person out of contaminated area to fresh air. If breathing has stopped, resuscitate and administer oxygen if readily available. Get medical attention immediately.

EY E CONTAC T Immediately flush eye with plenty of cool, running water. Remove contact lenses if applicable and continue flushing for at least 15 minutes, holding eyelids apart to ensure thorough rinsing of the entire eye. Get medical attention immediately.

SKIN CONTAC T Immediately flush skin with plenty of cool running water for at least 15 minutes. Wash with soap and water. If irritation develops or persists, get medical attention. Remove contaminated clothing and shoes; wash before reuse.

NOTE TO Information pertaining to ingestion toxicology, therapy, symptomatology and treatment PHYSICIAN can be found in Clinical Toxicoloav of Commercial Products, authored bv Gosselin,

Smith and Hodge and published by Williams & Wilkins, Baltimore, Maryland.

KDUX^IECHHOm Material Safetv Data Sheet

Product Name: Redux 300 Effective date: 12/15/2009 MSDS#: 15 Page 3 of 6

SECTION 5 ~ FIRE FIGHTING MEASURES

FLAS H POINT/METHO D None / N.A. FLAMMABL E LIMITS Not flammable or combustible

EXTINGUISHING MEDIA Use extinguishing media appropriate for surrounding fire.

SPECIA L FIRE FIGHTING Pressure demand self-contained respiratory protection and protective PROCEDURE S clothing should be worn by fire fighters.

FIRE AND EXPLOSIO N Not a fire or explosion hazard 1

HAZARDS

SECTION 6 - ACCIDENTAL RELEASE MEASURES

RESPONS E Absorb with inert material such as vermiculite, shovel into closeable container for TO SPILLS disposal. Thoroughly flush residual with water.

SECTION 7 - HANDLING AND STORAGE

HANDLING Wear proper safety equipment. Mix only with water. Follow appropriate tank entry PRECAUTION S procedures" (ANSrzi17 ) and OSH A Confined Space Regulations.

STORAG E Store in a cool, dry and well-ventilated place. Keep from freezing. PRECAUTION S Keep container tightly closed when not in use.

SECTION 8 ~ EXPOSURE CONTROLS / PERSONAL PROTECTION

HYGIENIC PRACTICE S Observe label precautions; use personal protective equipment. Avoid breathing mists or vapors of this product.

ENGINEERING CONTROL S Facilities using this product must be iequipped with an eyewash station. Local Exhaust: None

hEDUUJELHmLQQ7 Material Safetv Data Sheet

Product Name: Redux 300 Effectiv e date: 12/15/2009 MSDS# : 15 Pag e 4 of 6

PERSONA L PROTECTIVE EQU IPMENT X RESPIRATOR NIOSH/MSHA approved respirator where mists or sprays may be

generated. X GOGGLES / FACE Chemical splash goggles required; also use face shield if exposure is

SHIELD severe X APRON Required; PVC , Neoprene or Vinyl acceptable X GLOVES Required; use PVC , Neoprene or Nitriie with long gauntlet or protective

cuff X BOOTS Rubber

SECTION 9 -- PHYSICAL AND CHEMICAL PROPERTIES

A P P E A R A N C E Clear pale yellow liquid BOILING POINT > 212° F ODO R Slight Odor FREEZIN G POINT < 32° F

pH Approx. 3-4 V A P O R P R E S S U R E Similar to water SPECIFI C GRAVIT Y 1.1 V A P O R DENSIT Y Similar to water SOLUBILIT Y IN WATE R Complete EVAPORATIO N RAT E Similar to water

SECTION 10 -- STABILITY AND REACTIVITY

CHEMICA L STABILIT Y STABLE X UNSTABLE CONDITIONS TO AVOID Do not mix with anything but water.

INCOMPATIBILITY Do not mix with quaternay amines, acids, sulfides and strong oxidizers.

HAZARDOU S PRODUCT S Carbon dioxide and carbon monoxide. O F DECOMPOSITIO N

POLYMERIZATIO N WILL NOT MAY OCCUR OCCUR

CONDITIONS TO AVOID Not applicable

X

mux4JEcnmm7 Material Safetv Data Sheet

Product Name: Redux 300 Effective date: 12/15/2009 MSDS#: 15 Page 5 of 6

SECTION 11 ~ TOXICOLOGICAL INFORMATION

Oral: Rat LD5 0 = -9,00 0 mg/kg Dermal: Rabbit LD5 0 = >29,000 mg/kg Ey e Irritation: Corrosive Skin irritation Mild Irritant

CARCINOGENICIT Y THIS PRODUC T CONTAINS A KNOWN OR SUSPECTE D CARCINOGE N

THIS PRODUCT DOES NOT CONTAIN ANY KNOWN OR ANTICIPATED CARCINOGENS ACCORDING TO THE CRITERIA OF THE NTP ANNUAL REPORT ON CARCINOGENS AND OSHA 29 CFR 1910, Z

OTHE R EFFEC 1 rs ACUTE May be corrosive to all body tissues which it comes in contact. CHRONIC The chronic local effect may consist of multiple areas of superficial destruction ofthe

skin or of primary irritant dermatitis. Similarly, inhalation of dust, spray, or mist may result in varying degrees of irritation or damage to the respiratory tract tissues and an increased susceptibility to respiratory illness.

SECTION 12 ~ ECOLOGICAL INFORMATION

BIODEGRADABILITY CONSIDERED NOT BIODEGRADABLE BIODEGRADABLE

BOD/CO D VALUE Not established

ECOTOXICIT Y Ceriodaphnia: 48 hr LD50 = 2000 mg/1 NOAEL = 1000 mg/1

Fathead Minnow: 96 hr LD50 = 2000 mg/1 NOAEL = 1000 mg/1

iiEauxSiECHmoorMaterial Safetv Data Sheet

Product Name: Redux 300 Effective date: 12/15/2009 MSDS# : 15 Page 6 of 6

SECTION 13 ~ DISPOSAL CONSIDERATIONS

Product that cannot be used according tc the label must be disposed of per manufacturers WAST E DISPOSA L METHO D recomendations. Empty containers may be triple rinsed, then offered for recycling or reconditioning; or puncture and dispose of in a sanitary landfill.

R C R A CLASSIFICATIO N R E C Y C L E CONTAINE R YES X CODE 2 - H D P E NO

SECTION 14 ~ TRANSPORT INFORMATION

DOT CLASSIFICATION HAZARDOUS NOT HAZARDOUS

DESCRIPTION Not Hazardous under 29CF R 1910-1200

SECTION 15 ~ REGULATORY INFORMATION

R E G U L A T O R Y STATU S EPA REGISTERED (UNDER FIFRA) FDA REGULATED KOSHER SARA TITLE III MATERIAL USDA AUTHORIZED NSF APPROVAL

SECTION 16 ~ OTHER INFORMATION

NFP A CLASSIFICA T O N 1 BLUE HEALTH HAZARD 0 RED FLAMMABILITY 1 YELLOW REACTIVITY

WHITE SPECIAL HAZARD c

HEDUx^wamm.Division of Azure Water Services, LLC

Material Safetv Data Sheet

Product Name: Redux 620 Effective date: 2/27/2012 MSDS #: 56 Page 1 of 6

SECTION 1 ~ CHEMICAL PRODUCT AND COMPANY IDENTIFICATION

IDENTIFICATION

Product Name Redux 620 Chemica l Nam e Aqueou s Blended Deposit Control Agent Chemical Family Formula Synonym

COMPANY IDENTIFICATION

Redux Technology Division of Azure Water Services , LL C

280 Callegari Drive West Haven, CT 06516 Phone: 203-933-9071 Fax: 203-933-1751 Email: info@reduxtech.com

EMERGENCY TELEPHON E NUMBER

24 hours a day: CHEMTRE C 1-800-424-9300. Number for non-emergency questions concerning MSDS : 203-933-9071

SECTION 2 -- COMPOSITION / INFORMATION ON INGREDIENTS

Componen t C A S # Amoun t (%W/W)

WaterAcrylate CopolymerOrganic Phosphorous CompoundSulfonated Phosphonium SaltCaustic Soda

7732-18-5 Not Hazardous

Proprietary Proprietary

1310-73-2

-73 % - 3 %

- 3 % -20 % - 1 %

HEDUXiUCmSLmK Material Safetv Data Sheet

Product Name: Redux 620 Effective date: 2/27/2012 MSDS# : 56 Page 2 of 6

SECTION 3 ~ HAZARDS IDENTIFICATION

E M E R G E N C Y Eye and skin irritant. Prolonged or repeated skin may cause irritation. OVERVIE W

POTENTIA L HEALT H E F F E C T S

INGESTION May cause severe and permanent damages to mouth throat and stomach. May be fatal if swallowed.

INHALATION Damages ainways and lungs, depending upon amount and duration of exposure. Effects can vary from irritation to bronchitis or pneumonia.

EYE CONTACT May cause permanent damage, including blindness.

SKIN CONTACT Harmful contact, but may not cause immediate pain.

SECTION 4 - FIRST AID MEASURES

INGESTION If swallowed, DO NOT induce vomiting. Immediately drink a large quantity of water. If available, give large quantities of milk. Never give anything by mouth to an unconscious person. Get medical attention immediately. If vomiting occurs spontaneously, keep airway clear.

INHALATION Get person out of contaminated area to fresh air. If breathing has stopped, resuscitate and administer oxygen if readily available. Get medical attention immediately.

EY E CONTAC T Immediately flush eye with plenty of cool, running water. Remove contact lenses if applicable and continue flushing for at least 15 minutes, holding eyelids apart to ensure thorough nnsing ofthe entire eye. Get medical attention immediately.

SKIN CONTAC T Immediately flush skin with plenty of cool running water for at least 15 minutes. Wash with soap and water. If irritation develops or persists, get medical attention. Remove contaminated clothing and shoes; wash before reuse.

NOTE TO Information pertaining to ingestion toxicology, therapy, symptomatology and treatment PHYSICIAN can be found in Clinical Toxicoloqv of Commercial Products, authored by Gosselin,

Smith and Hodge and published by Williams & Wilkins, Baltimore, Maryland.

nEOUX^TEEWLBm Material Safetv Data Sheet

Product Name: Redux 620 Effective date: 2/27/2012 MSDS#: 56 Page 3 of 6

SECTION 5 ~ FIRE FIGHTING MEASURES

FLAS H POINT/METHO D None/N.A . FLAMMABL E LIMITS Not flammable or combustible

EXTINGUISHING MEDIA Use extinguishing media appropriate for surrounding fire.

SPECIAL FIRE FIGHTING Pressure demand self-contained respiratory protection and protective PROCEDURE S clothing should be worn by fire fighters.

FIRE AND EXPLOSIO N Not a fire or explosion hazard HAZARDS

SECTION 6 ~ ACCIDENTAL RELEASE MEASURES

RESPONS E Absorb with inert material such as vermiculite, shovel into closeable container for TO SPILLS disposal. Thoroughly flush residual with water.

SECTION 7 - HANDLING AND STORAGE

HANDLING Wear proper safety equipment. Mix only with water. Follow appropriate tank entry PRECAUTION S procedures (ANSI Z117) and OSH A Confined Space Regulations.

STORAG E Store in a cool, dry and well-ventilated place. Keep from freezing. PRECAUTION S Keep container tightly closed when not in use.

SECTION 8 ~ EXPOSURE CONTROLS / PERSONAL PROTECTION

HYGIENIC PRACTICE S Observe label precautions; use personal protective equipment. Avoid breathing mists or vapors of this product.

ENGINEERING CONTROL S Facilities using this product must be equipped with an eyewash station. Local Exhaust: None

HEDUXSTEamLOSl Material Safetv Data Sheet

Product Name: Redux 620 Effectiv e date: 2/27/2012 MSDS#: 56 Pag e 4 of 6

PERSONA L PROTECTIVE EQL IPMENT X RESPIRATOR NIOSH/MSHA approved respirator where mists or sprays may be

generated. X GOGGLES/FAC E Chemical splash goggles required; also use face shield if exposure is

SHIELD severe X APRON Required; PVC, Neoprene or Vinyl acceptable X GLOVES Required; use PVC, Neoprene or Nitriie with long gauntlet or protective

cuff X BOOTS Rubber

SECTION 9 - PHYSICAL AND CHEMICAL PROPERTIES

A P P E A R A N C E Clear pale yellow liquid BOILING POINT >212° F

ODO R Slight Odor FREEZIN G POINT <32° F

pH Approx. 4.3 V A P O R P R E S S U R E Similar to water SPECIFI C GRAVIT Y 1.13 V A P O R DENSIT Y Similar to water SOLUBILIT Y IN W A T E R Complete EVAPORATIO N RAT E Similar to water

SECTION 10 - STABILITY AND REACTIVITY

CHEMICA L STABILITY STABLE UNSTABLE CONDITIONS TO AVOID Do not mix with anything but water.

INCOMPATIBILITY Do not mix with quaternay amines, acids, sulfides and strong oxidizers.

HAZARDOU S PRODUCT S Carbon dioxide and carbon monoxide. O F DECOMPOSITIO N

POLYMERIZATIO N WILL NOT MAY OCCUR OCCUR

CONDITIONS TO AVOID Not applicable

X

dEDUXSTEEHmmi Material Safetv Data Sheet

Product Name: Redux 620 Effective date: 2/27/2012 MSDS#: 56 Page 5 of 6

SECTION 11 ~ TOXICOLOGICAL INFORMATION

Oral: Rat LD50 = 2,150 mg/kg Dermal: Rat LD50 = 7,500 mg/kg Eye Irritation: Corrosive Skin irritation Mild Irritant

CARCINOGENICITY THIS PRODUCT CONTAINS A KNOWN OR SUSPECTED CARCINOGEN

THIS PRODUCT DOES NOT CONTAIN ANY KNOWN OR ANTICIPATED CARCINOGENS ACCORDING TO THE CRITERIA OF THE NTP ANNUAL REPORT ON CARCINOGENS AND OSHA 29 CFR 1910, Z

OTHER EFFEC1rs ACUTE May be corrosive to all body tissues which it comes in contact. CHRONIC The chronic local effect may consist of multiple areas of superficial destruction ofthe

skin or of primary irritant dermatitis. Similarly, inhalation of dust, spray, or mist may result in varying degrees of irritation or damage to the respiratory tract tissues and an increased susceptibility to respiratory illness.

SECTION 12 ~ ECOLOGICAL INFORMATION

BIODEGRADABILITBIODEGRADABILITYY CONSIDERECONSIDEREDD XX NONOTT BIODEGRADABLBIODEGRADABLEE BIODEGRADABLBIODEGRADABLEE

BOD/COD VALUE Not established

ECOTOXICITY Rainbow trout: 96 hr LD50 = 450 mg/1 Bluegill sunfish: 96 hr LD50 = 350 mg/1

HEDUXlfEEmSLSBZ Material Safetv Data Sheet

Product Name: Redux 620 Effective date: 2/27/2012 MSDS# : 56 Page 6 of 6

SECTION 13 -- DISPOSAL CONSIDERATIONS

Product that cannot be used according to the label must be disposed of per manufacturers W A S T E DISPOSA L recomendations. Empty containers may be triple rinsed, then offered for recycling or

METHO D reconditioning; or puncture and dispose of in a sanitary landfill.

R C R A CLASSIFICATIO N Non-Hazardous R E C Y C L E CONTAINE R YE S X COD E 2 -HDP E NO

SECTION 14 - TRANSPORT INFORMATION

DO T CLASSIFICATIO N HAZARDOUS NOT X HAZARDOUS

DESCRIPTION

SECTION 15 ~ REGULATORY INFORMATION

REGULATOR Y STATU S EPA REGISTERED (UNDER FIFRA) FDA REGULATED KOSHER SARA TITLE III MATERIAL USDA AUTHORIZED NSF APPROVAL

SECTION 16 ~ OTHER INFORMATION

NFP A CLASSIFICA T O N 2 BLUE HEALTH HAZARD 0 RED FLAMMABILITY 1 YELLOW REACTIVITY

WHITE SPECIAL HAZARD c

ATTACHMENT B

Q MWH

EPA-REGION 7 SHALLOW INJECTION WELL REGISTRATION/INFORMATION VERIFICATION RECORD

FACILITY INFORMATION (Complete a separate form for each Facility that has an Injection Well)

Facility Name' Former Peoples Natural Gas Site

Facility Contact: Not Applicable Title­ Not Applicable

Address­ Kerper Boulevard

City: Dubuque State: lowa Zip: 52001

County: Dubuque Phone: Not Applicable

Number of Employee's (full and part time):

EP A Identification Number(s): IAD980852578

IDNR Identification Number(s): Not Applicable

FACILITY OWNER INFORMATION (If different than Facility Information) Name- MidAmerican Energy Company

Address- ^^^ ̂ Northwest Urbandale Drive

City: Urbandale State: 'owa Zip: ,. 50322

Phone: (712) 352-5434

INJECTION WEL L INFORMATION (Complete this section for each Injection Well at Facility)

Well Type: CESSPOO L • DRAINAGE WELL • DRY WELL • HEAT PUM P RETURN FLOW WELL •

SEPTIC SYSTE M • (tank size in gallons: )

OTHER a (please describe: Groundwater Extraction Wells )

Well Status; PROPOSE D Q ACTIVE • ABANDONE D • PLUGGE D •

Approximate Date Installed: Fall 2012 |f piygggd or Abandoned, When?

Well Location: Township: Range: ̂ Section: 1/4 Section:

Latitude: Longitude:

Depth of Well (In Feet): 40 Injection Formation: Silty Sand Alluvial Aquifer

Nature of Injected Fluid(s)- P^dux 300 (inorganic sequestering agent) and Redux 620 (biodispersant)

Has any chemical analysis been done on the injectate? YE S • NO a (if yes please attach copies of

the results)

FACILITY WATER SUPPLY

Municipal / Public / Rural: YE S • NO • Private: YE S Q NO • (if yes, answer the following questions)

Is the water supply well at the facility used for human consumption: YE S • NO •

Is the well protected with a backflow preyention device: YE S • NO •

SianatureC Date:

Owner i^Operator •

OMB No. 2040-0042